Amsacrine (Amsidine, m-AMSA)

Amsacrine is a chemotherapy drug used to treat some types of lymphoma and acute adult leukaemia. It is also called amsidine or m-AMSA.

One of the ways amsacrine works is by blocking an enzyme called topoisomerase 2. If this enzyme is blocked the cell's DNA gets tangled up and the cell can't split into 2 new cancer cells. Amsacrine also works as an alkylating agent. This is a type of chemotherapy drug that works by sticking to one of the cancer cell's DNA strands.

Amsacrine is a red liquid that you have through a drip (intravenous infusion) through a fine tube (cannula) put into one of your veins. The drip takes about an hour. Or you may have it through a central line, portacath or PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You usually have this type of chemotherapy as a course of several cycles of treatment. The treatment plan for amsacrine depends on which cancer you are being treated for. You may have amsacrine daily for between 3 and 5 days, every 3 to 4 weeks. There is information about planning chemotherapy in the chemotherapy section.

The side effects associated with amsacrine are listed below. You can use the links to find out more about each side effect. Where there is no link, please see the cancer drug side effects section or use the search box at the top of the page.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. 
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia).

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal from 6 months to a year after their treatment ends
• A sore mouth and throat – you may have mouth ulcers and red, sore skin inside your mouth 2 to 3 days after each treatment, which usually clears up within 3 weeks
• Feeling or being sick affects 3 out of 10 people (30%) but is usually well controlled with anti sickness medicines
• Your urine may become a pink or red colour for one or two days after treatment but this is not harmful
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby  is important to you
• Women may stop having periods (amenorrhoea) but depending on your age, this may only be temporary
• Amsacrine may have a harmful effect on a developing baby – do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant

Between 1 and 10 in every 100 people have one or more of these.

• Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working
• Hair loss or thinning
• Pain and swelling at the injection site
• Abdominal pain
• Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days

Fewer than 1 in 100 people have these.

• Temporary damage to the heart muscles, which can affect your heart rhythm – in most people this will go back to normal after the treatment is completed
• Very rarely, this drug can cause heart failure so your heart will be checked before you start treatment
• Fits (seizures)
• Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons – this starts within a few days or weeks and usually goes within a few months of finishing treatment
• Headaches
• Confusion

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment. Or you may develop more side effects as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.